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Access to healthcare for Migrants

Access to healthcare for Migrants

Access to healthcare for Migrants

Wednesday, September 26, 2018

Bethan Lant, Casework Manager at Praxis Community Projects, talks to us about access to healthcare for Migrants.

In October 2017 there were changes to access to healthcare which has made it more difficult for those with insecure immigration status or unable to evidence their immigration status to access many medical services. This was highlighted in dramatic fashion earlier this year when the Guardian published the story of Praxis client Albert Thompson, who had been refused treatment for prostate cancer despite having lived continuously in the UK for over 40 years. This illustrated the problems that even those who should have a right to be in the UK can experience, but while the government has begun to address the problem of those who can’t evidence their status, those who do not have the right immigration status can still legally be denied medical care.

There is a stark divide between access to primary (mostly GP) care and secondary care (care generally provided in hospitals). The practice among many GP surgeries of demanding to see a passport as a condition of registration has led to a belief that irregular migrants are barred from using GP services. However, this is not the case; GPs are able to take any person onto their practice list regardless of immigration status. The experience among migrants though is that they are commonly refused access because of their immigration status. Knowing and being able to assert their rights can help migrants to access GP services. Healthy England has produced a wallet-sized card which clarifies the rights of all those experiencing homelessness, including migrants, to register with a GP.

While there have been issues about NHS Digital (the service which holds all health service data including GP records) sharing patient’s personal information with the Home Office through a data-sharing agreement, this was suspended by the government earlier this year.

Access to secondary care is a thornier issue. While some care is free to all (Accident & Emergency care, family planning services excluding healthcare, mental health treatment under certain sections of the Mental Health), most medical services are only free to those who are classed as ‘ordinarily resident’. Some migrants are exempt from the ordinary residence test, for example refugees, but for some migrants, particularly those with irregular status, secondary care will not be accessible unless they can pay for it in advance. No one should be refused treatment which is deemed ‘urgent or immediately necessary’ and the decision on this should be made by a clinician, not an administrator. However, what is deemed ‘urgent or immediately necessary’ can be difficult to define, and those receiving such care can still be billed for that care once they have received it. So, for example, while all pre-natal care and scans are deemed ‘immediately necessary’ care, if a pregnant migrant is told that she will be given a substantial bill for any service that is provided, that is a strong disincentive to attend future appointments. A debt to the NHS of more than £500 can be taken into account by the Home Office when making a decision on a person’s immigration application, and some hospitals pursue outstanding debts aggressively through debt collectors.

Working out entitlement to secondary healthcare can be difficult. Attached is a presentation which outlines the basic rules around access to secondary healthcare. Essentially, it runs through a series of questions that should be asked:

- Is the treatment exempt from charging?
- Is the person an exempt category of person?
- Is the person ‘ordinarily resident’?
- Is the treatment ‘urgent or immediately necessary?

If the answer to any of the first three questions is ‘yes’ then the person will be able to access treatment free of charge. If the answer to the first three questions is ‘no’, but the answer to the fourth question is ‘yes’ then the person should be given immediate treatment but will be charged for the treatment received. If the answer to all four questions is ‘no’ then the person will not be able to access treatment unless they can pay for it in advance.

All of these questions are complex and require further guidance.  Doctors of the World have recently produced an excellent online toolkit giving more advice on migrants’ rights and entitlements to healthcare. Maternity Action also has a range of factsheets about entitlement to healthcare which, while aimed primarily at migrant women, are often applicable to all migrants. 

Any person who wishes to be oppose the restrictions on access to healthcare for migrants can contact Docs Not Cops and find out more about their #PatientsNotPassports campaign

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